Research Posters
Introduction/Objective
Nurse reports of missed care are associated with adverse patient outcomes and considered an indicator of the quality and safety of patient care. However, not all aspects of nursing care are of equal significance to patient outcomes. Three processes—recognition and response to indeterminate or abnormal fetal heart rate changes within 15 minutes, excessive uterine activity within 20 minutes, and new maternal complications within 10 minutes—were determined to be critical because serious harm to the pregnant woman and/or the fetus can occur if they are missed. The study examined the rates of three critical nursing care processes on labor and delivery units and assessed the relationship with reports of reduced nursing time at the bedside and frequency of unit staffing adequacy during the COVID-19 pandemic in the United States.
Methods
A Web-based survey was administered to a national convenience sample of registered nurses on labor and delivery units between January 14, 2021, and February 26, 2021. Descriptive analyses were conducted on respondent characteristics and self-reported missed-care items. Robust logistic regression analysis was used to assess the relationship of missed care with reports of reduced nursing time at the bedside since the COVID-19 pandemic and frequency of unit staffing adequacy.
Results
Among the 836 respondents, 33% reported that at least one of the three critical processes of nursing care was missed in the past month by themself or nursing staff on their unit. Respondents who agreed that nurses were spending less time at the beside had greater odds of missing critical aspects of care compared with respondents who disagreed (adjusted odds ratio [AOR] = 1.77, 95% CI [1.12, 2.80]), and respondents who reported that unit staffing was adequate 75% of the time or more had lower odds of missing critical aspects of care than those who reported unit staffing was adequate 50% of the time or less (AOR = 0.54, 95% CI [0.36, 0.79]).
Discussion/Conclusion
These findings warrant considerable attention to nurse staffing. Policies and practices are needed to ensure that critical surveillance and action processes are always done, especially during times of disruption, and to maintain the quality and safety of maternity care.